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El <br />PUOLIC WORKS PERMIT AWLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT ADDRESS: 4123 HOYT AVE <br />IF APPLICABLE: [ _] LAND USE PROJECT # (SEPA, PRE-APP, SS, ETC.) <br />SITE WORK FOR PROJECT TYPE: LJSFR-DETACHED =SFR-ATTACHED 771DUPLEX =MULTI -FAMILY =COMMERCIAL <br />CHANGE OF USE? = NO = YES, FROM TO <br />LEWAT ER / SEWER SERVICE NEEDED? = NO = YES, TYPE SIZE <br />SITE WORK / RIGHT-OF-WAY APPLICATION INFORMATION <br />DESCRIPTION OF WORK: SITE WORK FOR 2 DUPLEXES <br />= FENCE IN ROW <br />FT IN HEIGHT <br />= DRIVEWAY APRON / CURB CUT <br />FT WIDE <br />=ASPHALT/ CONCRETE PAVING <br />SF <br />0 RETAINING WALL / ROCKERY IN RIGHT-OF-WAY <br />LF <br />= RETAINING WALL / ROCKERY OVER 4FT IN HEIGHT <br />FT TOTAL HEIGHT <br />= CLEARING / GRADING / FILL / EXCAVATE <br />CY <br />0 CUT/BORE IN PAVEMENT (PARALLEL) <br />LF <br />CUT/BORE IN PAVEMENT (NON -PARALLEL) <br />LF <br />CONTACTINFORNIA710N ^; <br />OWNER NAME: MURPHY MANAGEMENT SERVICES CORPORATION <br />OWNER MAILING ADDRESS: STREET <br />7110 48TH AVE W <br />CITY <br />MUKILTEO STATE WA ZIP <br />OWNER PHONE: <br />APPLICANT NAME: ELAINE GROTH <br />OWNER EMAIL: <br />APPLICANT MAILING ADDRESS: STREET <br />CITY <br />STATE ZIP <br />APPLICANT PHONE: 4258764447 <br />PRIMARY CONTACT: I I OWNER I <br />APPLICANT EMAIL: ESG4DESIGN@GMAIL.COM <br />_1 APPLICANT = OTHER (Architect, Engineer, Etc.) <br />CONTACT NAME: ELAINE GROTH <br />CONTACT PHONE: 4258764447 <br />CONTACT EMAIL: ESG4DESIGN@GMAIL.COM <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must <br />comply with current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be <br />authorized in writing from the Building Official before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to <br />perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Authorized Agent/Owner Date <br />City of Everett Official Use Only <br />PERMIT # <br />PW1612-043 <br />(Revised 1011212015) <br />